Get Patient Clinical History Form - Ddaplano.com

Filling out the Patient Clinical History Form is a crucial step in receiving appropriate medical care. This guide will provide you with clear and supportive instructions to complete the form online, ensuring that all necessary information is accurately captured for your examination.

Follow the steps to effectively complete the form online.

1. Press the ‘Get Form’ button to access the Patient Clinical History Form and open it in the designated editor.
2. Enter your personal details in the designated fields, including your name, height, weight, and date of birth. Ensure accuracy as this information is essential for your medical records.
3. In the ‘Reason for Exam’ section, provide a brief description of the symptoms or conditions leading to your examination. Be as detailed as possible.
4. Indicate the onset of symptoms by writing the date they first appeared or describing their progression.
5. If applicable, specify whether you have experienced an injury. If you select 'Yes,' provide an explanation and the date of the injury.
6. Indicate whether you have a history of cancer. If 'Yes,' please specify the location of the previous cancer.
7. List any previous surgeries you have had by providing details in the designated field.
8. Complete the section on prior imaging studies related to your symptoms by filling out the type of study, date, and facility for each relevant examination, including radiographs, CT scans, and MRIs.
9. Remember to note any other imaging studies you have had, completing the respective fields.
10. At the end of the form, you may find fields for departmental staff. This includes contrast type, amount, NDC/Lot number, creatinine, GFR, and result date. Ensure this information is filled out as required.
11. Choose the appropriate injection site information as outlined, including the type of angiocath or butterfly used and the injection site, noting whether it is on the right or left side.
12. After filling out all necessary fields, review the form for completeness and accuracy. Then save your changes, and choose the option to download, print, or share the form as needed.

Complete your Patient Clinical History Form online today for a smoother examination experience.